AI Summary
5 min readWhen Daniel Kahneman, the Nobel-winning psychologist, turned 90 in relatively good health, he traveled to Switzerland and ended his life. In an email to friends, he wrote that he had believed since his teenage years that “the miseries and indignities of the last years of life are superfluous.” Kahneman’s decision was deliberate and personal, but it also struck some people close to him as selfish—one friend told the economist Al Roth that Kahneman had left them “bereft,” robbing them of a year or two more of his company. Roth, who has spent his career studying what he calls “repugnant transactions,” says he would have argued against it if he had been closer to Kahneman. But he also says he would not want to legislate his opinion. That tension—between personal autonomy and the social, moral, and medical stakes of choosing the timing of one’s own death—is the central question of this episode.
The framework: repugnance and the slow march of legalization
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What you'll learn
- 1 (00:33) **Episode Introduction: Kahneman's Choice & the "Repugnance" Frame** - Host Stephen Dubner introduces the episode via Daniel Kahneman's decision to end his life in Switzerland, framing the debate through economist Al Roth's concept of "repugnant transactions."
- 2 (06:42) **Al Roth: Market Design & Repugnant Transactions** - Roth discusses his work on kidney exchange and why some markets (like organ sales) lack social support, setting the stage for medical aid in dying as a repugnant transaction.
- 3 (12:06) **New York Governor Kathy Hochul: A Personal Case for the Law** - Hochul explains her decision to sign New York's Medical Aid in Dying Act, driven by her mother's death from ALS.
- 4 (14:57) **Political & Religious Opposition to Hochul's Law** - Hochul describes the long fight to pass the bill and the intense opposition from the Catholic Church.
- 5 (18:38) **The Suicide Prevention Paradox** - Dubner asks Hochul how she reconciles legalizing medical aid in dying with the state's significant spending on suicide prevention.
- 6 (20:09) **The Opposition Case: Bad Medicine, Bad Ethics** - Dubner introduces Dr. Daniel Sulmasy of Georgetown, who argues medical aid in dying is "bad medicine, bad ethics, and bad public policy."
- 7 (30:26) **The Slippery Slope & The Canadian Warning** - Sulmasy warns that safeguards in U.S. laws are already being eroded (e.g., eliminating waiting periods and residency requirements), pointing to Canada's system where 1 in 20 deaths are assisted.
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Show Notes
New York is the latest state to legalize medical aid in dying. Stephen Dubner speaks with the governor who signed the law, a Nobel Prize-winning economist, a death doula — and an ethicist who thinks the very idea is wrong.
- SOURCES:
- Kathy Hochul, governor of New York.
- Suzanne O'Brien, death doula, founder of Doulagivers Institute.
- Al Roth, economist at Stanford University.
- Daniel Sulmasy, physician, philosopher, director of the Kennedy Institute of Ethics at Georgetown University.
- RESOURCES:
- Moral Economics: From Prostitution to Organ Sales, What Controversial Transactions Reveal About How Markets Work, by Al Roth (2026).
- "New York Moves to Allow Terminally Ill People to Die on Their Own Terms," by Grace Ashford (New York Times, 2025).
- The Good Death: A Guide for Supporting Your Loved One through the End of Life, by Suzanne O'Brien (2025).
- The Future of Assisted Suicide and Euthanasia, by Neil Gorsuch (2009).
- EXTRAS:
- "Make Me a Match (Update)," by Freakonomics Radio (2023).
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